HHS Agency to Create Community Care Hub Learning Network

Sept. 9, 2022
Administration for Community Living is supporting the development and integration of networks of state and community-based organizations to advance the integration of medical and social care

In some areas of the country, newly formed Community Care Hubs are offering access to regional or statewide networks of community-based organizations to provide one-stop shopping for health systems and payers looking for partners on social determinants of health efforts. Now the federal Administration for Community Living (ACL) is planning to launch a national learning community of these hubs to share best practices.

Speaking at the NAACOS fall conference, Kelly Cronin, deputy administrator, innovation and partnership at HHS’ Administration for Community Living, explained the increasing importance of these hubs.

She said that as ACOs are managing total cost of care, they are going to be highly motivated to figure out holistic models that involve community-based organizations. “What we have recognized is you can't necessarily do that by contracting for 20,000 CBOs; that's just not tenable,” Cronin said. “We want to make it easier to work with CBO networks. When we think about Medicaid and Medicare Advantage contracts, often their footprints go beyond a state. We need to have the flexibility to expand CBO networks to meet the geographic footprints of the healthcare partners. We need to be able to be flexible and have lead organizations be able to step up and say, ‘Okay, I can manage these contracts at these different levels and eventually assume risk.’”

In her role at ACL, Cronin leads the administration of programs and initiatives that serve both older adults and people with disabilities, including consumer access and protection programs.  She directs efforts to develop and integrate networks of state and community-based organizations to address social determinants of health and to advance the integration of medical and social care to improve health outcomes of older adults and people with disabilities. She previously served in a variety of other roles at HHS, including with the Office of the National Coordinator for Health IT (ONC), where she coordinated health IT programs and policies associated with healthcare payment and delivery system reform.

“We know we need to simplify this,” she stressed. “We know we need to build the capacity on the CBO side to be able to have one contracting entity or what we're calling a Community Care Hub that can be that accountable entity and that can be a partner that can think about the workforce development and the quality improvement benchmarks, and what needs to happen from a data infrastructure standpoint to be able to get the quality reporting back to you — not just the closed loop, but what are the outcomes and be a trusted partner to the ACO or to a health plan.”

In one example of this type of work, the ACL selected Bay Aging to lead the development of a statewide Community Integrated Health Network for Virginia. The two-year project began in September 2021 and is funded by a No Wrong Door Community Infrastructure grant. Also speaking at the NAACOS conference was Kathy Vesley, president and CEO of Bay Aging.

“Our model is a statewide model,” Vesley stressed. “We have 25 Area Agencies on Aging in Virginia and we are one of them. Most of the other 24 sister agencies are bigger, stronger, and doing more. But we really wanted to get involved in healthcare. We really could see the needs are in the communities and how we could help the health systems, and so then we decided to build it out statewide with managed care coming into Virginia.”

Vesley said they knew this had to be statewide to work. “No one wanted to contract with 25 separate agencies to have services, much less the many different community-based organizations that we deal with. We are the contractor with the health entities. We have several ACO partners and we have health plan partners. This makes it very easy for them. In turn, we are subcontracting with agencies across the state. When we get a referral, we are able to offer one contract for a statewide service. There is one source of accountability, be it for the billing, the reimbursements, reporting the data and inputting the data — all the things that you know you're going to need to have. That has been a big success for us.”

Cronin pointed to other areas of progress. There is a group called the Partnership to Align Social Care that was launched in the last year. It is bringing together healthcare leaders, both from health plans and health systems, together with a lot of CBO leaders, who have experience doing this work to try to figure out how to co-design this and scale it nationally.

The partnership is working on how to define a Community Care Hub. “They are also looking at how we could potentially set some standards for it so we could credential it,” Cronin said. “If you're looking for a community partner, where do you go and how do you know that they're good? How do you know you can trust them? So an accreditation or certification process is being contemplated. They're iterating on other standards, but they have come up with a definition that everyone has agreed on.”

Cronin mentioned that in the Accountable Health Communities program, a lot of health systems stepped up to be the lead entity. That has led to concern that this effort also is going to end up being a medical model. “Fundamentally, there's a lot of fear that this shouldn't all be about a medical model and empire building for large health systems that want to grow,” she said. “They really want it to be a trusted community entity that's managing the CBOs across a community, one that can be a neutral party and a trusted party to everybody and hold many different contracts across healthcare.”

“We're all going to have to figure this out together,” Cronin said. “It's not one size fits all or that healthcare can't be involved as a hub. I think we need to figure out what the shared services look like together. There might be places where an FQHCs might be a good hub, particularly in rural areas. Just because they deliver clinical care doesn't mean they shouldn't be a Community Care Hub.”

“Right now, we know that there are many of these hubs across the country that have the ability to manage those CBO networks and they can be a contracting entity. We're going to be launching a national learning community in the coming months.” Funding will be coming out over the next several months to help support the growth of these Community Care Hubs, she added.

“We have about 38 of these Community Care Hubs across the country. As we launch this national learning community over the next two months, we're going to get a lot more data. Several of the hubs do offer statewide capabilities. In Alabama, Massachusetts, Ohio, and Indiana, there are really good statewide competencies. In those states you can go beyond one local community if you want a contracting entity or Community Care Hub.”

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